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Kidney Dialysis Company Expands Into The Hospital Business

NPR Health Blog - Mon, 11/10/2014 - 3:35pm
Kidney Dialysis Company Expands Into The Hospital Business November 10, 2014 3:35 PM ET


Eric Whitney Listen to the Story 2 min 33 sec  

Dialysis giant DaVita HealthCare Partners is moving into the hospital business.

Courtesy of DaVita HealthCare Partners Shots - Health News Medicare Penalizes Nearly 1,500 Hospitals For Poor Quality Scores Shots - Health News Medicare Fines Record Number Of Hospitals For Excessive Readmissions

Critics of America's health care system say it's really a "sick care" system. Doctors and hospitals only get paid for treating people when they're sick.

But that's starting to change. Health insurance companies and big government payers like Medicare are starting to reward doctors and hospitals for keeping people healthy.

So, many health care companies are trying to position themselves as organizations that help people stay well.

One of the latest is DaVita HealthCare Partners, a provider of kidney dialysis services. The company operates 2,152 dialysis centers in the U.S. and 87 in its fast-growing international buisiness.

DaVita is making a move into primary care, and it just announced a joint venture with a hospital company in Colorado and Kansas.

DaVita CEO Kent Thiry says it's like changing the company from being an electrician into a general contractor. "And in so doing," he says, "[We] have a much more comprehensive impact on how the house gets designed, how it gets built, how it gets maintained for the betterment of those who live in the house. That's the simplest way to characterize the change."

DaVita's partner in the new venture is Centura Health, the biggest hospital company in Colorado. Like DaVita, it is also expanding aggressively into primary care and services beyond hospital-based procedures.

Centura CEO Gary Campbell says that in order for his company to keep people healthy, it needs the ability to crunch lots of health data. The idea is to use computer systems to keep track of peoples' health, and flag health problems before they happen. He says DaVita HealthCare Partners is really good at that.

"Our physicians have gone scouring around the country, and believe that Health Care Partners really has the premier analytics."

So, if DaVita wants to grow substantially beyond the current 168,000 dialysis patients it serves now, it needs to expand beyond just kidney care, says Mark Stephens with Prima Health Analytics. In 2012, the company started buying big doctors practices in several states. It's hoping that its experience caring for very sick dialysis patients will help it manage family practices, and now, make hospitals more efficient.

Stephens also says DaVita might also be trying to create a model for Medicare to follow. That agency currently picks up the tab for about 85 percent of all Americans getting dialysis. He says Medicare has been offering dialysis companies opportunities to assume responsibility for those patients' health care beyond dialysis, but that the companies haven't found the deals attractive so far.

If DaVita's new joint venture is successful, and it lowers the cost of care for both dialysis patients and those who aren't as sick, the company may be able to win lots of new business from Medicare and private insurance companies.

This story is part of reporting partnership with NPR and Kaiser Health News.

Copyright 2014 Montana Public Radio. To see more, visit
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California Nurses Say They'll Strike, Without Talking Wages

NPR Health Blog - Mon, 11/10/2014 - 1:24pm
California Nurses Say They'll Strike, Without Talking Wages November 10, 2014 1:24 PM ET


April Dembosky

A nurse at the University of California Medical Center in San Francisco protests lack of Ebola preparedness in October. The issue will be the focus of national demonstrations Wednesday.

Justin Sullivan/Getty Images

As many as 18,000 nurses in Northern California are preparing for a two-day strike that will start Tuesday. Nurses plan to leave their posts at 7 a.m. and picket outside 21 Kaiser Permanente medical centers and clinics.

The placards nurses carry and the chants they repeat will say little about salaries or pensions. No economic proposals have even been put on the bargaining table yet.

"This seems awfully quick to go to a strike," says Joanne Spetz, an economics professor at the University of California, San Francisco School of Nursing. "I can't recall a situation where a strike has come up where there has not been some kind of disagreement about wages and benefits as part of the package."

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Instead, nurses are focusing on more than 35 operational proposals that remain unresolved after three months of bargaining. These demands include a call to fill more than 2,000 nursing positions that have been vacated in the last three years, better protections for use of sick leave or more flexibility over breaks, and more training and education.

Both sides have leaned on the recent Ebola scare to try to win PR points with the public. Nurses have demanded better protective gear and more training for caring with potential Ebola patients — calls that the Centers for Disease Control and Prevention heeded by updating its federal guidelines last month. Kaiser nurses say they still want more, and have timed the second day of their strike to coincide with nurse demonstrations across the country in a "National Day of Action" over Ebola preparedness.

The hospital system has tried to turn that argument around in light of the work stoppage.

"We are baffled by the union's tactics at this critical time," read an ad that Kaiser ran in Northern California newspapers Monday. Calling a strike now, "just as we are entering flu season, and when the nation and our members are concerned about the risk of Ebola, seems particularly irresponsible."

Kaiser Permanente is running ads in Northern California papers in advance of the proposed strike.

Lisa Aliferis/KQED

The hospital system has hired and trained more than 2,800 temporary nurses to staff its medical centers while its regular nurses are on strike, a stopgap that costs as much as $20 million per day, Kaiser says. Some elective surgeries and non-urgent appointments will be rescheduled to ease pressure on the system.

"Our main concern is patient care issues and safe staffing," says Zenei Cortez, co-president of the California Nurses Association and chair of the bargaining team for the Kaiser nurses.

She says Kaiser will only agree to changes that are "cost neutral," which is one reason the proposals are stuck in limbo.

The main tension in the negotiations is over what's not being said. Nurses say they are eager to incorporate the subject of wages and benefits into the negotiation. While they have made no formal economic proposals, they have stated that they are seeking the status quo: no cuts.

Kaiser is quiet on this. It has not put forward any of its own proposals yet. The hospital system said in a statement that it prefers to resolve a majority of the "other issues the union has already put on the table and then add our wage and benefit proposals to the mix."

Shots - Health News California Nurses Union Braces For Contract Battle

Experts say this is all unusual. But the move to isolate patient care demands from economics could be a strategy on either side, says Spetz.

Because the nurses' patient-care proposals would both cost money and create a benefit to nurses in their working conditions — by reducing workload, for example — it makes sense that they would want to balance these requests against any proposed changes to salary and benefits.

"Usually these all get negotiated as a group," says Spetz.

Kaiser may prefer to separate the issues as a way to strengthen its position when negotiating over wages and pensions. Nurses in California are among the few private professions to still have pensions.

But nurses may benefit from the separation, too, now that they've called a strike.

"To the extent the union can clearly state what exactly their concerns are and argue that Kaiser is not listening, that can bring a lot of public sympathy," Spetz says. "It does not benefit Kaiser to be perceived as (being) against patient safety."

Copyright 2014 KQED Public Media. To see more, visit
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5 Tips To Get The Most Out Of Obamacare

NPR Health Blog - Mon, 11/10/2014 - 12:13pm
5 Tips To Get The Most Out Of Obamacare November 10, 201412:13 PM ET

Partner content from

Mary Agnes Carey

Look no farther for the top things to watch out for when shopping for health insurance on the online marketplaces.

Giorgio Magini/iStockphoto

The second open enrollment season for health insurance offered through marketplaces created by the Affordable Care Act is just around the corner. Are you ready?

Here's a quick checklist for people who don't get their health insurance at work and plan to shop for coverage on the health law's online exchanges. Enrollment starts Nov. 15, but you can start kicking the tires now.

Compare plans and prices at or, if your state has its own exchange, shop there to find out which coverage is best for you. And you may be eligible for subsidies to help pay your premium.

Keep these five things in mind as the three-month open enrollment period begins.

Shop Around: Just because you're enrolled in a policy now doesn't mean it's the best deal for you next year. If you're currently in the federal marketplace and don't take any action, you'll be re-enrolled in the same plan. Federal officials, as well as many analysts, are urging consumers to go back to the exchanges to compare plans and prices. You might discover that you have more — or different — choices than you had a year ago.

Don't Get Billed Twice: Insurers have expressed concerns that if a consumer changes plans, problems with the federal website might keep insurers from learning of the change and consumers could get billed for both plans. "It's an issue we're aware of, and we're working with exchange officials to make sure there's a solution for consumers," said Clare Krusing, a spokeswoman for America's Health Insurance Plans, an industry trade group. Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said insurers will get lists of individuals who have been automatically enrolled into their current plan as well as those who chose to re-enroll. He also said the agency is "examining options" on how to provide insurers the names of people who picked another plan during open enrollment.

Just in case, keep proof of payment to answer any billing questions, and once you've cancelled the old policy, watch your credit card statements, or, if the payment was deducted directly from a bank account, watch those charges to make sure you aren't paying for two policies. And don't cancel your current insurance until you have confirmation from your new carrier that you're covered.

Find Out If You Qualify For Financial Help: Enter your most up-to-date income information on or with your state exchange to see if you are entitled to receive a tax credit toward the cost of your health insurance. Even if you are like the majority of those enrolling in marketplace plans who receive a subsidy, update your income to make sure you get the correct amount next year. This is important because if you get too much of a subsidy, you'll have to repay it when you file your taxes the following year.

Know All Costs: It's not just the monthly premium that will cost you. Understand a policy's out-of-pocket costs, things like copays, co-insurance and deductibles, before you enroll. The health law allows out-of-pocket maximum caps of $6,600 for an individual policy and $13,200 for a family policy in 2015, but some of your health care expenses — including out-of-network care — might not be included in that cap.

Confused? Get Help If You Need It: There are several ways to get help. Work with a local insurance agent or broker. Find one of the law's trained navigators or assistors. Or call the federal consumer assistance center at 800-318-2596 for a hand or to find out if you are eligible for a subsidy. Folks there can also help you enroll in a health plan or, if you qualify, Medicaid, the federal-state program for low-income people.

Copyright 2014 Kaiser Health News. To see more, visit
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